Preventive care for MPSERS Medicare members

Abdominal aortic aneurysm (AAA) screening

Medicare members with certain risk factors for AAA

Once in a lifetime, with a referral from your doctor

Alcohol misuse screening and counseling

All Medicare members

Annually

If you screen positive for alcohol misuse, you can get up to four in-person counseling visits per year (you must be alcohol free during counseling).

Annual Wellness Visit (AWV)

 All Medicare members. If you've had Medicare Part B (Medical Insurance) for longer than 12 months, you can get a yearly "Wellness" visit to develop or update a personalized prevention plan based on your current health and risk factors. Advanced Care Planning is an optional preventive service at no cost to the member only when given with an AWV. When furnished not during the AWV a cost share would apply to the member.

Once per calendar year

Bone mass measurement

Medicare members who are at risk of losing bone mass, risk of osteoporosis, glucocorticoid therapy for more than 3 months or primary hyperparathyroidism

Once every 24 months or more frequently if medically necessary

Breast cancer screening (breast exams and mammograms)

All female Medicare members

Breast exams: Every 24 months

Screening mammograms: One baseline at 35-39 years old, annually 40+

Cardiovascular disease risk reduction visit

All Medicare beneficiaries without apparent signs or symptoms of cardiovascular disease

Annually

Cardiovascular disease screening

All Medicare members

Once every 5 years, when ordered by a doctor

Cervical (Pap test) and vaginal (pelvic) cancer screening

All female Medicare members

Pap test & pelvic screenings: Every 2 years

Pap test annually if at high risk of cervical cancer or if you've had an abnormal Pap test within the past 3 years and are of childbearing age

Colorectal cancer screening

All Medicare members age 50 and older, but there is no minimum age for having a covered screening colonoscopy.

Consult with your physician on the type of screening you need and the frequency (anywhere from 12-120 months): Guaiac-based fecal occult blood test (gFOBT), fecal immunochemical test (FIT), DNA based colorectal screening, flexible sigmoidoscopy, colonoscopy, barium enema, Cologuard

Depression screening

All Medicare members

Annually

Diabetes screening

Medicare members at risk or with pre-diabetes

Up to 2 tests per year with referral from your doctor

Diabetes self-management training (DSMT)

Medicare members with diabetes

As prescribed by your doctor

Frequency: Initial year: Up to 10 hours of initial training within a continuous 12-month period

Subsequent years: Up to 2 hours of follow-up training each calendar year after the initial 10 hours of training has been completed

Glaucoma screening

Medicare members with diabetes or a family history of glaucoma, African-Americans age 50 or older, and Hispanic-Americans age 65 or older

Annually

Hepatitis B Virus (HBV) infection screening

Medicare covers HBV infection screenings if you meet certain conditions

Annually

Hepatitis C (HCV) screening

Medicare members at high risk due to: Current or past history of illicit drug use, or blood transfusions prior to 1992, or born between 1945-1965

Once per lifetime, or annually for certain people at risk

HIV screening

All Medicare members between the ages of 15 and 65. Those at an increased risk less than age 15 or older than age 65.

Annually or up to 3 times during a pregnancy

Human Papillomavirus (HPV) screening

Must be performed along with a pap test.

All asymptomatic female Medicare members 35-65 years old

Once every 5 years

Immunizations: COVID-19 shots

All people with Medicare

Medicare covers FDA-authorized COVID-19 vaccines. For the latest information, visit the Priority Health COVID-19 vaccine information page.

Immunizations: Flu shots

All people with Medicare

Once each flu season

Immunizations: Pneumococcal shots

All people with Medicare

Most people only need one shot once in their lifetime. A different, second shot, is covered 11 months after you get the first shot. Talk with your doctor or other qualified health care provider to see if you need these shots.

Immunizations: Hepatitis B shots

Members who are at medium or high risk for Hepatitis B

Three shots are needed for complete protection. Check with your doctor about when to get these shots if you qualify to get them.

Lung cancer screening

Medicare members who meet all of these criteria:

• Age 55-77
• Asymptomatic and do not have symptoms of lung cancer
• Current smoker/quit smoking in the last 15 years
• Have a tobacco smoking history of at least 30 "pack years" (average of 1 pack/day for 30 years)

Annually, when ordered by your doctor

Medical nutrition therapy (MNT)

Certain members who have a referral from their treating physician, diagnosed with diabetes or renal disease or who has had a kidney transplant within the last 36 months.

3 hours of counseling the first year and 2 hours the following year(s). Services delivered by a registered dietician or nutrition professional.

Medicare Diabetes Prevention Program (MDPP)

Medicare members that could prevent or delay type 2 diabetes.

Once per lifetime

Obesity screening and therapy to promote sustained weight loss

Medicare members with BMI greater than 30

Consult with your physician; Medicare covers behavioral therapy sessions to help you lose weight. 15-30 minute sessions (depending on individual or group counseling) may be covered if you get in a primary care setting (like a doctor's office), where it can be coordinated with your other care and a personalized prevention plan.

Prostate cancer screening

All male Medicare members age 50 or older

Annually for a digital rectal exam and prostate specific antigen (PSA) test.

Sexually transmitted infections (STIs), screening and counseling

Medicare members at increased risk for STIs, or pregnant women

Every 12 months, or at certain times during pregnancy

Smoking and tobacco use cessation (quit) counseling

All Medicare members who use tobacco

Up to 8 visits in a 12-month period

Welcome to Medicare preventive visit

All Medicare members

Within the first 12 months you have Medicare Part B